CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Piedmont Macon North Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $2,260
Cash Discount Price: $2,202
vs. Medicare Baseline: 6.34x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Piedmont Macon North Hospital is $2,260. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,202. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 6.34x the Medicare baseline. Located in 400 Charter Boulevard, Macon, GA.

Cash / Self-Pay

$2,202

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,260

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $2,202 (618%)

Insurance Median: $2,260 (634%)

Cash: $2,202 (618% of Medicare)

Ins. Median: $2,260 (634% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 634% of the Medicare baseline (a markup of 534%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Medicaid / KanCare	$675 - $1,183	189%
UnitedHealthcare	$916	257%
Cigna	$955	268%
Aetna	$2,260	634%
Phcs [10601]	$4,405	1236%
Industry Buying Group [10840]	$4,772	1339%
First Health [10303]	$5,139	1442%
Novanet [10819]	$5,506	1545%
Beechstreet [10800]	$5,873	1648%
Multiplan [10600]	$6,607	1854%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $2,202.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70553.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Piedmont Macon North Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70553.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.